Leigh Ann Laube

Kandi Arnold recently showed how to prepare an infant for safe sleep using a mannequin. Babies should sleep alone, on their backs and in a crib. (David Grace)

For years, nurses at Indian Path Medical Center's Family Birth have been teaching parents that babies should be put to sleep on their backs. Now, thanks to a partnership with the Tennessee Department of Health, the Family Birth Centers at Mountain States Health Alliance facilities are taking that instruction a step further by promoting the ABC's of safe sleep for infants — an infant should sleep Alone, on his or her Back and in a Crib.

Twenty percent of all infant deaths in Tennessee are due to unsafe sleep practices. Although Sudden Infant Death Syndrome (SIDS) has decreased in Tennessee, preventable sleep-related deaths are on the rise. A primary cause of sleep-related infant death is suffocation, which can happen with an adult rolls over on an infant or when an infant is smothered by pillows or blankets. Out of a thousand babies born in Tennessee in 2012, seven did not reach their first birthdays because of sleep-related deaths.

"If we can prevent that 20 percent, Tennessee wouldn't be in the five bottom states. By preventing what is preventable, we could be in the national average for infant mortality. We don't want to be known for our children dying in their sleep," said Terri Christian, clinical manager of Family Birth Center at Indian Path.

Research has shown that babies can't sleep on their sides or stomachs because they could aspirate or smother themselves, Christian said.

"There are some theories that they could breathe in their own carbon dioxide or could smother. They may get into such a deep sleep that they fail to breathe," she said. "The Back to Sleep campaign has been taught for several years — they play on their tummies, sleep on their backs."

Studies have shown that when parents go home, they put their babies to sleep the same way they see their baby positioned in the hospital. But at home, babies do not have the same monitoring and supervision as in the hospital.

That's why Niswonger Children's Hospital, Johnson City Medical Center and Franklin Woods Community Hospital in Johnson City, and Indian Path Medical Center in Kingsport have implemented a safe-sleep policy for all infants in the hospital. Team members who care for infants receive annual training that includes education on best practices for a safe sleep, and how to educate new parents on placing babies to sleep when they go home.

"In the hospital for the few days that we have them, they watch us," Christian said. "You learn more through vision than through hearing. We show them what to do, not only tell them. For several years now we've been doing the back to sleep thing. The majority of the deaths have been from sleeping with a parent. When they sleep, they need their own environment. We tell them the facts."

Christian said historically the biggest obstacle in getting parents to put their babies to sleep on their backs is because those parents mimic what their parents or grandparents did, and that could mean putting a baby to sleep in an unsafe way.

"Twenty percent of babies in the state of Tennessee die from unsafe sleep practices. Could it be yours?" Christian asks parents. "We mimic it here. When we go in and find their baby asleep on them, we say, 'Let me put your baby in the crib.'"

MSHA Family Birth Centers promote the American Academy of Pediatrics recommendations that infants should:

* Always be placed on their backs to sleep.

* Sleep alone in a crib or bassinet; although, the crib or bassinet can be in the same room as an adult caregiver.

* Not have bumper pads, blankets, stuffed animals, toys or pets in their cribs.

* Sleep on a firm crib mattress with the mattress covered only by a fitted sheet.

"They're knowing the back to sleep part. We've got that down really well. The part we need to emphasize is the co-sleeping. The back to sleep part is out there. It's the 'Don't overheat the baby. Don't put all the blankets, all the stuffed animals around your baby's face. Make sure there's air flow around the room. And, they need to be in their own bed.'"

Before discharging parents and their babies, Indian Path staff have a sit-down instruction time, Christian said.

"We have a set of things that we need to know they know — how to use that bulb syringe, don't smoke around the baby, safe sleep practices. We have a very planned discharge instructions that goes out to every parent, but you're talking to them at a time when they're tired. We use that 24 to 48 hours that we have [in the hospital] to teach every minute. Then we cap it out by talking to them at discharge. We also give them a new mom's handbook with everything we talked to them about," she said.

Christian hopes this new partnership will see a reduction in the number of sleep-related infant deaths.

"I think this next year will tell us. I know Mountain States has hit it hard. It's an improvement project for this coming year. We've brought it to the forefront. We have so much to teach them in such a short amount of time. We've put this on the priority list and we emphasize it more," she said. "I think it will make a difference. I hope it will make a difference. I don't like to be on the bottom of anything."